The FAME Model: Conceptualizing End-of-Life Doulas’ Roles within Compassionate Communities

Abstract

As the U.S. population ages and interest in community-based approaches to death and dying grows, end-of-life doulas (EOLDs) are reshaping how individuals, families, and communities experience dying. Drawing on 23 interviews with practicing doulas, we identify the FAME model: facilitator, advocate, mediator, and educator. As facilitators, doulas make end-of-life plans actionable through practical, emotional, and existential support; as advocates, they amplify the voices of dying individuals and their families within healthcare institutions; as mediators, they navigate interpersonal dynamics and emotional tensions; and as educators, they demystify death and clarify options that are often unknown or misunderstood. Beyond identifying these roles, the FAME model delineates role boundaries, conceptualizes doula work in functional rather than spatial terms, and provides clearer language for articulating the scope of practice within this emerging field. Ultimately, we explore how doulas bridge Mallon’s micro model, Abel’s circles of care, and compassionate communities frameworks through micro-level caregiving, meso-level community engagement, and macro-level social change.